Hepatic gas gangrene following orthotopic liver transplantation: three cases treated with re-transplantation and a review of the literature

Transpl Infect Dis. 2008 Jul;10(4):280-5. doi: 10.1111/j.1399-3062.2007.00287.x. Epub 2007 Dec 7.

Abstract

Gas gangrene is a rare and devastating infectious process that can occur after liver transplantation, most often following hepatic artery thrombosis. We here report 3 cases of gas gangrene following orthotopic liver transplantation. Blood cultures were positive for Clostridium clostridiiforme in one case. In 2 other cases liver tissue from explanted specimens was positive for Enterobacter cloacae. Ultrasound demonstrated hepatic artery thrombosis and computed tomography imaging revealed diffuse liver necrosis with gas formation in each case. All 3 patients were successfully treated with a combination of antibiotics and emergent re-transplantation. We review previously published cases of gas gangrene after liver transplant and emphasize the importance of hepatic artery thrombosis in the development of this syndrome as well as the frequent involvement of non-clostridial organisms. Early diagnosis and aggressive combined medical and surgical treatment including re-transplantation are essential for successful treatment of these rare and catastrophic infections.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Blood / microbiology
  • Clostridium / isolation & purification
  • Clostridium Infections* / complications
  • Clostridium Infections* / diagnosis
  • Clostridium Infections* / drug therapy
  • Clostridium Infections* / microbiology
  • Culture Media
  • Enterobacter cloacae / isolation & purification
  • Enterobacteriaceae Infections* / complications
  • Enterobacteriaceae Infections* / diagnosis
  • Enterobacteriaceae Infections* / drug therapy
  • Enterobacteriaceae Infections* / microbiology
  • Female
  • Gas Gangrene / diagnostic imaging
  • Gas Gangrene / drug therapy*
  • Gas Gangrene / etiology
  • Gas Gangrene / microbiology*
  • Hepatic Artery / surgery
  • Humans
  • Liver Diseases* / diagnostic imaging
  • Liver Diseases* / drug therapy
  • Liver Diseases* / microbiology
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Radiography
  • Thrombosis / diagnostic imaging
  • Thrombosis / etiology
  • Thrombosis / surgery
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Culture Media